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User
Posted 04 Nov 2024 at 11:48

Hi

I have been give the diagnosis of Prostate Cancer.  The cancer was found in 5 out of over 20 biopsies, it is non aggressive and confined to the prostate. I was informed that I will have 3 options (depending on the MDT meeting).  Active monitoring, Surgery or Sabr radiotherapy.  The thought of it escaping while being monitored scares me. 

Bit of background my daughter has stage 4 secondary breast cancer, the cancer spread!  I am very used to the whole cancer world now.

I have tried to get as much information I can of the risks and side effects of the other 2 options.

Surgery - I have diabetes and do not heal as fast as I could without it. It is major surgery and I think this is a no as there seems to be lots of possible side effects.

Sabr - cutting edge and from what I can see the side effects are a lot less than the older method.  It is delivered as 5 days of intense sessions.  

I am leaning to Sabr if offered.  

I am really looking for any input that may help me gain confidence in the decision of Sabr.

User
Posted 04 Nov 2024 at 12:06

Hi Den.

I'm sorry that you've had to join the Club, but welcome to the forum.  I'm also very sorry to hear about your daughter's breast cancer.

If possible could you please give us a little more information about your diagnosis. Your Gleason score and PSA level would be helpful. I assume that your cancer staging is T2?

Initially I was diagnosed with low grade, low volume, T2a disease, my PSA was 5.6. I went on active surveillance. Unfortunately my disease progressed and I had surgery. Had 5 session SABR been an option, I'd have probably taken it. 

Edited by member 04 Nov 2024 at 16:35  | Reason: Typo

User
Posted 05 Nov 2024 at 13:57
We are at a time of inovation for the way old and sometimes fairly new treatments are used for dealing with Prostate Cancer. For example, originally a main use for SABR was as Peter says as a salvage treatment, particularly useful where surgery had left a small and well defined area that could be blasted with a large number of concentrated beams fired in a tight group but at different angles. Normal RT embraces a larger area where the extra cover extends more for greater spread. So in areas where the cancer is more concentrated and defined SABR may in some cases be a better option even as a primary treatment so why not use it? Also, there has been a growing tendancy to reduce the number of fractions of RT but at a higher dosage where in my understanding the way was paved in the CHHiP Trial about 15 - 18 years ago. The normal numer of fractions given at the time was 37 each of 2 Grays. The CHHip hypofractioned trial had 2 other arms providing 19 and 20 fractions each of a doseage of about 3 Grays. Overall, it was shown that results could be just as effective using 20 fractions of higher dosage and super hypofractional treatment is likely to be a further development. It means fewer visits for patients and set ups for radiographers but also a reduction of the total amount of Grays given. It also means that radiation can be more appropriately taylored to individuals. More advanced machines for dispensing radiation have also helped.

Though not mentioned by the OP, earlier use of chemo and various drugs is another area where advances have improved outcomes.

Barry
User
Posted 05 Nov 2024 at 23:16

Originally Posted by: Online Community Member
I asked about likely options and mentioned SABR in case my situation was seen as a good fit. He stated SABR is currently not available in the NHS, and training is underway. He thought it a long time off before being one of the standard treatment options.

Is that correct?

I think it is available at some NHS hospitals down south, but perhaps they're still trialing it. In fact, I recall a bloke on here, posting he'd had it done recently. 

 

Edited by member 05 Nov 2024 at 23:30  | Reason: Typo

User
Posted 05 Nov 2024 at 23:20

Oh wow, SABR treatment is available on the NHS, but it may not be available at all hospitals. SABR also has different uses. SABR was used in the pace trial. I have had SABR treatment to a single pelvic lymph node. The SABR treatment was done on the NHS. An in-law had SABR treatment to his prostate,also on the NHS.

Thanks Chris 

 

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User
Posted 04 Nov 2024 at 12:06

Hi Den.

I'm sorry that you've had to join the Club, but welcome to the forum.  I'm also very sorry to hear about your daughter's breast cancer.

If possible could you please give us a little more information about your diagnosis. Your Gleason score and PSA level would be helpful. I assume that your cancer staging is T2?

Initially I was diagnosed with low grade, low volume, T2a disease, my PSA was 5.6. I went on active surveillance. Unfortunately my disease progressed and I had surgery. Had 5 session SABR been an option, I'd have probably taken it. 

Edited by member 04 Nov 2024 at 16:35  | Reason: Typo

User
Posted 05 Nov 2024 at 12:40

Hi, SABR sounds very attractive if it's only 5 sessions.   I've read that a lower number of high intensity doses is a new treatment. 

On the other hand SABR isn't new and is usually offered for individual bone lesions as far as I know.  I've not heard it being offered as a prime treatment on the prostate.   Mind you I don't know a lot about it.

To be offered surgery or SABR is an odd choice as surgery is a major prime treatment and SABR as far as I know isn't.  So I think I'd be asking whether it's the new standard or conventional SABR and if it's conventional SABR I'd be asking if it's really enough.  If it's new or experimental high dose you might be expected to be warned of the risks.

I hope the above makes sense.  There are people on here who know more if they're around, Old Barry is good on SABR.  I'd be diplomatic asking such questions anyway as the doctor may take the hump.

All the best, Peter

User
Posted 05 Nov 2024 at 13:12

Hi Peter.

A link to the new treatment that's already being rolled out. I don't think you even need HT with it.

https://www-bbc-co-uk.cdn.ampproject.org/v/s/www.bbc.co.uk/news/health-66946336.amp?amp_gsa=1&amp_js_v=a9&usqp=mq331AQIUAKwASCAAgM%3D#amp_tf=From%20%251%24s&aoh=17308121510899&referrer=https%3A%2F%2Fwww.google.com

Its a huge step forward. they are now doing trials to try and reduce it to only two sessions and on higher grade cancer.

https://bmccancer.biomedcentral.com/articles/10.1186/s12885-024-12165-1

 

 

Edited by member 05 Nov 2024 at 13:29  | Reason: Not specified

User
Posted 05 Nov 2024 at 13:57
We are at a time of inovation for the way old and sometimes fairly new treatments are used for dealing with Prostate Cancer. For example, originally a main use for SABR was as Peter says as a salvage treatment, particularly useful where surgery had left a small and well defined area that could be blasted with a large number of concentrated beams fired in a tight group but at different angles. Normal RT embraces a larger area where the extra cover extends more for greater spread. So in areas where the cancer is more concentrated and defined SABR may in some cases be a better option even as a primary treatment so why not use it? Also, there has been a growing tendancy to reduce the number of fractions of RT but at a higher dosage where in my understanding the way was paved in the CHHiP Trial about 15 - 18 years ago. The normal numer of fractions given at the time was 37 each of 2 Grays. The CHHip hypofractioned trial had 2 other arms providing 19 and 20 fractions each of a doseage of about 3 Grays. Overall, it was shown that results could be just as effective using 20 fractions of higher dosage and super hypofractional treatment is likely to be a further development. It means fewer visits for patients and set ups for radiographers but also a reduction of the total amount of Grays given. It also means that radiation can be more appropriately taylored to individuals. More advanced machines for dispensing radiation have also helped.

Though not mentioned by the OP, earlier use of chemo and various drugs is another area where advances have improved outcomes.

Barry
User
Posted 05 Nov 2024 at 22:54

I am currently on AS, but awaiting a 2nd biopsy, template this time under GA.

I asked about likely options and mentioned SABR in case my situation was seen as a good fit. He stated SABR is currently not available in the NHS, and training is underway. He thought it a long time off before being one of the standard treatment options.

Is that correct?

SABR seems to be getting more and more mentions, but is it restricted to certain areas or maybe just trials?

User
Posted 05 Nov 2024 at 23:16

Originally Posted by: Online Community Member
I asked about likely options and mentioned SABR in case my situation was seen as a good fit. He stated SABR is currently not available in the NHS, and training is underway. He thought it a long time off before being one of the standard treatment options.

Is that correct?

I think it is available at some NHS hospitals down south, but perhaps they're still trialing it. In fact, I recall a bloke on here, posting he'd had it done recently. 

 

Edited by member 05 Nov 2024 at 23:30  | Reason: Typo

User
Posted 05 Nov 2024 at 23:20

Oh wow, SABR treatment is available on the NHS, but it may not be available at all hospitals. SABR also has different uses. SABR was used in the pace trial. I have had SABR treatment to a single pelvic lymph node. The SABR treatment was done on the NHS. An in-law had SABR treatment to his prostate,also on the NHS.

Thanks Chris 

 

User
Posted 05 Nov 2024 at 23:32

OK thanks guys, so appears it is being used on NHS.

I was hoping it is (or would become) an option as primary treatment in addition to the usual RP, RT and Brachy.

Of course its not always going to be a suitable option, but if it was, 5 sessions possibly without HT sounds like quite an attractive option. Don't doubt its going to be limited to certain scenarios of PC.

Has anyone found any success in asking for treatment at another hospital in a different region, or is that rather unlikely given there seems to be an explosion of PC diagnosis these days? I'm not suggesting I wouldn't get suitable care where I am, just mulling over possibilities.

 
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